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Wednesday, June 23, 2004

on call again

I've been on call a lot lately. Just saying.

So I've been going through an existential reckoning lately, in which I'm in the process of critically examing what I'm doing with my life and why I'm doing it. There comes a point where you wonder whether or not that path you chose is the right path, or just the past of least resistance. There's still no doubt in my mind that I want to do Pediatrics. I want to be a doctor, I want to treat kids. I'm just not all that sure that I want to be a Pediatrician. There's a difference, you know.

There are moments in Peds where your job really hits you as something special. As much as I don't wallow in the sappiness intrinsic in Peds, there are some moments that you really expect to see in some tearjerker "ER" episode in which cute children are mercilessly exploited to manipulate our emotions. Like yesterday, for instance. There's a terminally ill child on our team who has been in the hospital for several weeks, and who, as a result of her hospitalization, missed her kindergarden graduation. She was very upset about this. She wanted to wear her pink cap and gown. She wanted to get her diploma. So to make things up to her, we had a mock graduation ceremony in Child Life. We got her all dressed up in her graduation finery, presented her with a diploma, hummed "Pomp and Circumstance," and served strawberry shortcake in compliance with her low-fat diet. All the doctors and nurses involved in her care were there, and many of us brought her presents. So there she was in the middle of the Child Life suite, resplendent in pink nylon, one hand holding onto her chest tube, the other spooning fat-free Cool Whip onto my slice of strawberry shortcake, and you'd have to be made of stone not to at least get a little misty in the eyes, even if you couldn't quite let it show.

And then there are other moments in Pediatrics where you're just confronted with the most terrible things you've ever seen in your life. Ever. Like the patient with epidermolysis bullosa that I just sent home today. (Click on the link to learn about the disease, see pictures here, here, or here. I guess I should warn you that they're graphic, but whatever, you're big kids.) It's an interesting and rare diagnosis, and I have to admit that I was curious to see what was going on under all those bandages, since the kid was wrapped up like a mummy from head to toe on admission. So I watched one of his daily dressing changes. And it was without a doubt one of the most horrifying things I've ever seen in my life.

Not even any one thing, but all of it together--the kid's hoarse screeches of pain that drew people in from the hallway, the weeping ulcerated lesions covering every surface of his skin, the smell of pus and infected flesh and soaked bandages hanging thick in the air, all that gory stuff that is the stuff of residency war stories, but ten times worse somehow when it happens in a kid. I stayed for a few minutes and then I just had to leave. It wasn't even the goo so much as the pain. It was like watching torture. It was like that scene in "The Elephant Man" when Treeves sees Merrick for the first time and his eyes fill with tears of horror and pity. This kid gets the dressings over his entire body changed every day. This torture is his life. And those are the kinds of moments that make me understand why people don't choose to go into Pediatrics. Not because they don't like kids, but precisely because they do.

Currently reading: A back issue of "People" magazine found lying around the callroom.